CDI Reimbursement Manager MCW Medical Group

Summary

The CDI Managing Liaison serves as a strategic partner within the Clinical Documentation Integrity (CDI) program collaborating closely with Clinical Departments and CPS teams. This role advances the CDI mission by optimizing professional billing and reimbursement through the integration of frontend operations to reduce denials and revenue leakage.

Embedded within the CDI structure the Managing Liaison works with department leadership clinicians revenue cycle partners and ancillary services to identify and implement process improvements that enhance the overall revenue cycle experience. The role ensures documentation integrity operational efficiency and compliance with regulatory and billing standards while supporting accurate representation of the care delivered.

Primary Responsibilities

• Collaborate with Clinical Departments CPS and CDI leadership to identify and resolve clinical and financial concerns related to coding documentation charge capture billing and reimbursement.
• Evaluate opportunities to improve coding accuracy documentation quality and charge capture processes to ensure compliant and accurate reimbursement
• Coordinate and collaborate activities related to CDI CPS and Enterprise Registration for workflow improvement opportunities.
• Function as a process improvement liaison between CPS teams and clinicians to improve tactics for seamless billing and collection processes.
• Analyze accounts receivable (AR) and financial reports including monthly write-off reports ad hoc reports and physician logs to identify trends summarize outcomes and track key performance indicators relevant to CDI initiatives.
• Monitor charge and payment report to ensure appropriate workflow for services rendered.
• Investigate and escalate follow up on encounters coordinating with billing specialists and reimbursement teams to resolve discrepancies and ensure timely collections.
• Identify billing and reimbursement issues develop improvement initiatives and implement action plans to reduce write-offs and enhance revenue supporting CDI-driven documentation improvement efforts.
• Provide ongoing training and education to clinicians residents and clinical support staff on professional billing practices coding guidelines documentation standards use of modifiers and payer policies in collaboration with CDI.
• Support billing-related activities including epic enhancements for accurate reimbursement denials avoidance. Advise on cost and package in appropriate instances.
• Participate in billing meetings and committees to represent CDI and departmental interests contributing to system-wide improvements.
• Lead and support special reimbursement projects as assigned in coordination with CDI initiatives.
• Prepare and support appeal creation and submission for denied claims utilizing standard system reports and self-generated analyses in alignment with CDI documentation standards.
• Collaborate with CPS teams/leaders to maintain and enhance departmental policies and procedures related to complex or sensitive billing and reimbursement issues and ensure alignment with CDI protocols.
• Serve as the primary point-of-contact for department leaders and faculty regarding coding billing documentation denials reimbursement and payer policies under the CDI teams guidance with dissemination and connecting of CDI and CPS resources and support.
• Collaborate with CPS and others to ensure accurate charge capture setup for new services and CPT codes.
• Provide clinical coding support and education to coding including evaluation of tools and resource deployment.
• Participate in new provider orientation to convey expected provider support available from CDI team.
• Share applicable provider tools and resources available that will optimize documentation practices and efficacies.
• Safeguard and strengthen relationships with internal and external stakeholders to support departmental financial health and CDI objectives.
• Perform other duties as assigned to support the overall goals of the department and organization.

Knowledge Skills Abilities

• Comprehensive understanding of clinic operations professional billing workflows reimbursement practices and revenue cycle management.
• Strong knowledge of procedure coding CPT/HCPCS codes use of modifiers payer policies and documentation standards.
• Working knowledge of insurance and managed care principles including pre-authorizations referrals and payer requirements.
• Proficiency in electronic medical records (EMR) systems and professional fee billing platforms ability to extract and analyze clinical and financial data.
• Advanced proficiency in Microsoft Office products; ability to create and interpret complex reports and data sets.
• Knowledge of quality control customer service standards information management procedural processes and recordkeeping practices.
• Strong analytical and critical thinking skills with the ability to identify trends investigate issues and develop actionable solutions.
• Excellent written and verbal communication skills including the ability to present complex information clearly to diverse audiences.
• Effective interpersonal and listening skills with a professional and confident demeanor in interactions with clinicians staff and leadership.
• Ability to manage multiple tasks and priorities simultaneously demonstrating flexibility and adaptability in a dynamic healthcare environment.
• Experience conducting audits preparing reports and supporting appeals and reimbursement initiatives.
• Ability to provide education and training to clinicians residents and staff on billing coding documentation and reimbursement processes.
• Diligence and accuracy especially in reviewing financial data coding practices and billing documentation.
• Patience and diplomacy in resolving sensitive or complex issues across departments and with external stakeholders.
• Capacity to lead and participate in improvement initiatives policy development and special projects related to reimbursement and charge capture.

Qualifications

Appropriate experience may be substituted for education on an equivalent basis.

Minimum Required Education: Bachelors degree or equivalent experience

Minimum Required Experience: 5 years Professional service coding experience. Application of payer policy review.

Preferred Certification / Licensure(s): Current coding certification through AHIMA or AAPC preferred. Candidates who are not currently certified must obtain an applicable coding certification within 18 months of hire.

Preferred Experience: Professional revenue cycle specialty coding experience.

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Physical Requirements

Work requires occasionally lifting moderate weight materials standing or walking continuously.

Work Environment

Occasional exposure to dust noise temperature changes or contact with water or other liquids. Work is performed in an environmentally controlled environment.

Sensory Acuity

Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.

Why MCW

• Outstanding Healthcare Coverage including but not limited to Health Vision and Dental. Along with Flexible Spending options
• 403B Retirement Package
• Competitive Vacation and Paid Holidays offered
• Tuition Reimbursement
• Paid Parental Leave
• Employee & Family Assistance Program (EFAP)
• Pet Insurance
• On campus Fitness Facility offering onsite classes
• Additional discounted rates on items such as: Select cell phone plans local fitness facilities Milwaukee recreation and entertainment etc.

For a brief overview of our benefits see: Benefits Overview

For a full list of positions see: MCW Careers

At MCW all of our endeavors from our internal operations to our interactions with our partners are driven by our shared organizational values: Caring Collaborative Curiosity Inclusive Integrity Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds experiences and perspectives through merit-based processes and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world and we recognize that a healthy and thriving community starts from within. Our values define who we are what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all then MCW is the place for you. For more information please visit our institutional website .

MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination:

The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty staff and students as well as ensuring equal educational opportunity employment and access to services programs and activities without regard to an individuals race color national origin religion age disability sex gender identity/expression sexual orientation marital status pregnancy predisposing genetic characteristic or military status. Employees students applicants or other members of the MCW community (including but not limited to vendors visitors and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.

Required Experience:

Manager